<!DOCTYPE html>
<html lang="zh" xmlns:th="http://www.thymeleaf.org" >
<head>
    <th:block th:include="include :: header('门店资质表修改')" />
</head>
<body>
<div class="ui-layout-center">
    <form id="form-SXtszMdzhglStorequalification-edit" class="customize-search-form">

        <div class="customize-form-group-container">
            <input type="hidden" id="id" name="id" th:value="${id}">

                    <div class="customize-form-group">
                            <label>企业名称:</label>
                        <input name="companyName" placeholder="企业名称" th:value="${companyName}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>法定代表人/营业者:</label>
                        <input name="legalRepresentative" placeholder="法定代表人/营业者" th:value="${legalRepresentative}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>营业执照注册号:</label>
                        <input name="businessLicenseRegistrationNumber" placeholder="营业执照注册号" th:value="${businessLicenseRegistrationNumber}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>地址:</label>
                        <input name="businessLicenseAddress" placeholder="地址" th:value="${businessLicenseAddress}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>营业范围:</label>
                        <input name="businessScope" placeholder="营业范围" th:value="${businessScope}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>营业执照有效期:</label>
                        <input name="businessLicenseValidityPeriod" placeholder="营业执照有效期" th:value="${businessLicenseValidityPeriod}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>营业执照:</label>
                        <input name="businessLicenseUrl" placeholder="营业执照" th:value="${businessLicenseUrl}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>互联网药品信息服务资格证书:</label>
                        <input name="internetPharmaceuticalInformationServiceCertificate" placeholder="互联网药品信息服务资格证书" th:value="${internetPharmaceuticalInformationServiceCertificate}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>互联网药品交易服务资格证书:</label>
                        <input name="internetPharmaceuticalTransactionServiceCertificate" placeholder="互联网药品交易服务资格证书" th:value="${internetPharmaceuticalTransactionServiceCertificate}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>药品经营许可证:</label>
                        <input name="pharmaceuticalOperationPermit" placeholder="药品经营许可证" th:value="${pharmaceuticalOperationPermit}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>食品经营许可证:</label>
                        <input name="foodOperationPermit" placeholder="食品经营许可证" th:value="${foodOperationPermit}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>医疗器械经营许可证:</label>
                        <input name="medicalDeviceOperationPermit" placeholder="医疗器械经营许可证" th:value="${medicalDeviceOperationPermit}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>第二类医疗器械经营备案凭证:</label>
                        <input name="secondClassMedicalDeviceFilingCertificate" placeholder="第二类医疗器械经营备案凭证" th:value="${secondClassMedicalDeviceFilingCertificate}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>药品经营质量管理规范认证证书:</label>
                        <input name="pharmaceuticalQualityManagementStandardCertification" placeholder="药品经营质量管理规范认证证书" th:value="${pharmaceuticalQualityManagementStandardCertification}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>医疗器械网络销售备案凭证:</label>
                        <input name="medicalDeviceNetworkSalesFilingCertificate" placeholder="医疗器械网络销售备案凭证" th:value="${medicalDeviceNetworkSalesFilingCertificate}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>执业药师注册证:</label>
                        <input name="pharmacistRegistrationCertificate" placeholder="执业药师注册证" th:value="${pharmacistRegistrationCertificate}" class="styled-input" type="text">
                    </div>
                    <div class="customize-form-group">
                            <label>入驻药急送平台协议:</label>
                        <input name="platformEntryAgreement" placeholder="入驻药急送平台协议" th:value="${platformEntryAgreement}" class="styled-input" type="text">
                    </div>
        </div>
    </form>
</div>
<div class="main-content">
    <div class="col-sm-offset-5 col-sm-10">
        <button type="button" class="btn btn-sm btn-primary" onclick="submitHandler()"><i class="fa fa-check"></i>保 存</button>&nbsp;
        <button type="button" class="btn btn-sm btn-danger" onclick="closeItem()"><i class="fa fa-reply-all"></i>关 闭 </button>
    </div>
</div>
<th:block th:include="include :: footer" />
</body>
</html>
<script>
    function submitHandler() {
        var prefix = ctx + "xtsz/sxtszmdzhglstorequalification";
        if ($.validate.form()) {
            var data = $("#form-SXtszMdzhglStorequalification-edit").serializeArray();
            $.operate.saveTab(prefix + "/sXtszMdzhglStorequalificationEdit", data);
        }
    }
</script>
